Cleaning protocol for endoscopic instruments in gynecology

The procedure for cleaning endoscopic material include successive step which must be applied correctly: preliminary treatment, predisinfection or cleaning, rinsing, sterilization or disinfection. If sterilization is performed, the material is stocked until its next use. If cold disinfection is performed, the material is rinsed then stocked but cold disinfection must be performed again before using the material again. Personnel who manipulate must of course wear gloves. Cold disinfection is insufficient. Material used for endoscopic gynaecological surgery should be sterilized with an autoclave since it is the only method which can prevent infection.     

Hygienic maintenance of dental handpieces and turbines

The controversy over the effective sterilization and disinfection of dental handpieces has engaged the minds of dentists and researchers for years but has been made even more important with the advent of the HI virus and AIDS. In this article, initiated as a project by the FDI Commission, Prof. Dr. Klaus Bofsmann examines some of the problems and solutions of sterilization of dental equipment.     

Comparison of handpiece asepsis among Ohio dentists: 1991 & 1992

In 1991, we found that 23 percent of Ohio dentists sterilized handpieces between patients and 67 percent flushed handpieces between patients. In this study, we chose to investigate the changes in handpiece asepsis within Ohio dental offices for the twelve-month period ending August, 1992. Sixty-two percent of the 730 offices polled responded to the questionnaire. Offices reporting sterilization of handpieces between patients in 1992 is 80 percent compared to 23 percent in 1991. Sixty-nine percent of offices in the 1992 survey reported that they have changed infection control protocol to include heat sterilization of handpieces between patients while 24 percent report disinfection between patients. Back order of equipment, inadequate number of handpieces and fear of damage is cited by the offices using disinfection as the reasons for not sterilizing handpieces. Flushing handpieces between patients is reported by 83 percent of the offices. Previously, only 67 percent flushed between patients. Anti-retraction valves are present in 69 percent of the water lines. Breakdown of handpieces attributed to sterilization was reported by 45 percent of the offices. Two-hundred and three offices (45 percent) report questions from patients regarding office infection control policies. Infection control awareness of the general population and implementation of these procedures by dental professionals is increasing in Ohio.     

A comparative study of ethylene oxide and ionizing radiation for sterilizing bone grafts

To find a good way for sterilization and disinfection of bone grafts, we compared the sterilization capacity of gaseous ethylene oxide (EO) and cobalt-60 gamma radiation. The bone chips were contaminated with 10(7) bacteria per milliliter of Staphylococcus aureus ATCC 25923, Bacillus subtilis globigii 8017 and Bacillus cereus 4001, then sterilized with various doses of gaseous EO or cobalt- 60 gamma radiation. The sterilization effect of EO was more stronger and faster than that of 60Co gamma radiation. The application of moderate doses of EO for sterilizing particulate bone grafts was recommended.     

Molecular genetics of mating recognition in basidiomycete fungi

Patients with critical illnesses requiring aggressive medical intervention are at risk of acquiring serious nosocomial infection that may lead to increases in medical expenditures, morbidity, and mortality. Infection control in this population entails continuous surveillance for hospital-acquired infection, with investigation of outbreaks. Policies for effective antibiotic utilization, disinfection of medical devices and hospital environment, and patient isolation may limit nosocomial infection in this population. Finally, an effective infection control program should protect the health care worker from hospital-acquired infections through educational programs, routine health surveillance, vaccinations, and post-exposure care.     

Formation and elution of toxic compounds from sterilized medical products: methylenedianiline formation in polyurethane

The formation of a toxic and carcinogenic compound, methylenedianiline (MDA), in sterilized medical use polyurethane (PU) is discussed. Due to good biocompatibility and biostability, PU is widely used for blood-containing devices. There are two types of PU currently available for medical use. One is chain-extended thermoplastic PU, the other is thermosetting PU used for potting material connecting fibers and modules in artificial dialyzers and plasma separators. Both gamma-ray irradiation and autoclave sterilization are predominantly used for the sterilization of these devices. MDA formation in sterilized PUs by gamma-ray irradiation and by autoclave treatment is compared. The Delany clause in the USA prohibits the manufacture of medical devices producing any toxic compound during fabrication and sterilization, therefore, the formation and elution of MDA and other toxic compounds should be seriously considered. Although MDA formation at a concentration of a few to a few hundred ppb in autoclaved chain-extended thermoplastic PU has been reported, there have been no papers describing MDA formation in autoclaved thermosetting PU potting material, or describing MDA formation in gamma-ray irradiated chain-extended thermoplastic PU and thermosetting PU. We elected to determine whether MDA was in fact produced in Pus sterilized by gamma-ray irradiation or by autoclave sterilization. Our objective was to estimate the risk factor to the human patients or recipient. Our conclusion is to confirm which sterilization of gamma-ray or autoclave is more appropriate. No formation of MDA was observed in autoclaved thermosetting PU potting material at 121 degrees C for 60 min. A few ppm of MDA was formed in irradiated potting material. MDA formation increased with increasing irradiation doses. MDA formed in irradiated potting material at 2.5 Mrad (less than one ppm) is not a significant risk to the recipient. The estimated cancer causing risk factor when absorbing one mg MDA/kg body weight/day is 0.29. Twenty-nine persons per 100 persons exhibit a cancer potential. More importantly, our experimental evidence indicated that serum extracts from irradiated potting material contained unknown compounds other than MDA. The presence of these compounds is considerably more significant and toxic. When tested, these compounds proved to be mutagenic in the absence of metabolic activity, thus promoting a need to identify and study further. Compounds indicating mutagenicity increased with increasing irradiation. Small amounts of mutagenic compounds were determined in extract from autoclaved potting material, smaller than that by gamma-ray irradiation. Therefore, autoclave sterilization is more appropriate, providing materials can withstand the process.(ABSTRACT TRUNCATED AT 400 WORDS)     

Basic and clinical control of nosocomial infections

Nosocomial infections, especially opportunistic infections and occupationally acquired infections, are causing major problems in perioperative period. Opportunistic infections are increased by opportunism secondary to antibiotic therapy and lower body defences. Organisms that cause opportunistic infections come from either exogenous or endogenous sources. Exogenous infections result from transmission of organisms from a source other than the patient. Control of person-to-person spread, such as handwashing and gown technique, disinfection and sterilization of equipment, and environmental cleaning are necessary to prevent exogenous infections. Endogenous infections are caused by the patient's own flora. Antibiotic policies are required to prevent endogenous infections. The main preventive measure of occupationally acquired infections, especially blood-borne infections, is practices of universal precautions. Universal precautions are intended to prevent parenteral, mucous membrane, and nonintact skin exposures to blood-borne pathogens in health care settings.     

Endotherapy for chronic pancreatitis

This is a review of salient studies of sterilization, toxicity, biocompatibility, clinical applications and current work in the field of orthopaedics, using implants made of polylactic acid (PLA), polyglycolic acid (PGA) and their copolymers. The intrinsic nature of these biomaterials renders them suitable for applications where temporally slow releases of bioactive agents in situ may be required. They are also desirable as fixation devices of bone, because they can virtually eliminate osteopenia associated with stress shielding or additional surgery. The majority of currently available sterilization techniques are not suitable for these thermoplastic materials and it may be desirable to develop new sterilization standards, which can account for the special character of PLA-PGA materials. Biocompatibility and toxicity studies suggest that, overall, PLA-PGA biomaterials may be suitable for orthopaedic applications, although certain problems, especially pertaining to reduction in cell proliferation, have been reported. Clinical applications are also promising, albeit not without problems usually associated with transient tissue inflammation. The future of these materials appears bright, especially in soft tissues. They may be used to address the exceedingly complex problem of osteochondral repair, but also as a means to enhance fixation and repair processes in tendons and ligaments.     

Overview of polyethylene as a bearing material: comparison of sterilization methods

Polyethylene has been used for more than 30 years as an orthopaedic bearing material; however, there has been recent concern regarding the early failure of a small percentage of the polyethylene bearings. The damage seen in some retrieved polyethylene components has been linked to gamma radiation sterilization in air, which was widely used by the industry for years. Gamma radiation in air has been documented to cause an increase in oxidation and degradation of mechanical properties with time. The degradation of polyethylene initiated by gamma sterilization in air has led the orthopaedic industry toward alternative sterilization methods, including gamma radiation in an inert gas or vacuum environment, ethylene oxide gas sterilization, and gas plasma sterilization. For many of these alternative techniques, little clinical performance data exist. This study is a comparative evaluation of sterilization methods using the same analytic techniques that have been used to document the effects of gamma sterilization in air on polyethylene. Fourier transform infrared spectroscopy, electron spin resonance, and uniaxial tensile testing are used to compare, respectively, the oxidation levels, free radical concentration, and mechanical properties of material sterilized by each method. The polyethylene is evaluated before sterilization, poststerilization, and postartificial aging. All examined alternative sterilization methods, when compared with gamma sterilization in air, caused less material degradation during a component's preimplantation shelf life.     

Technical and economic feasibility of reusing disposable perfusion cannulas

OBJECTIVE(S): The reuse of disposable devices is a potential source of significant cost savings to hospitals. Venous and arterial perfusion cannulas under new and reused conditions were selected to identify the clinical, safety, technical, logistic, and economic issues that must be addressed to realize these savings. METHODS: Single- and dual-stage venous and arterial cannulas from two manufacturers were tested when new, after initial clinical use, and after a single clinical use plus up to nine simulated reuses. Reuse was simulated by end-to-end bending, coupling and uncoupling of the connectors, and by two 1-hour soaks in plasma at 4 degrees and 40 degrees C, respectively. Cannulas were decontaminated and then processed by a peracetic acid-based liquid chemical sterilization system after each use/reuse. Sterilization was validated by eliminating Bacillus subtilis spores from the cannulas on each of five consecutive cycles. Cannulas were tested for physical changes, functional integrity, biocompatibility, and in vivo performance in sheep. A cost analysis was also performed. RESULTS: Sterilization was successfully achieved. Mechanical changes were less than 20% on all variables studied and were undetectable by experienced cardiac surgeons in selective evaluation. No clinically important differences were found between new and reused cannulas, even after nine simulated reuses. Reusing cannulas four times would reduce the cost per procedure from $53 to $19 (64%). CONCLUSIONS: Preliminary data suggest that the perfusion cannulas tested can be safely and efficaciously used five times. Limited reuse of these disposable cannulas is technically feasible and cost-effective. Cannula reuse would result in a small incremental savings; however, with more expensive devices and higher-volume sterilization procedures, the savings could be considerably greater. This program provides a model for evaluation of other single-use medical devices for reuse.     

Response time studies of a new, portable mass spectrometer

Needleless connectors have been widely introduced into clinical practice to allow the connection of syringes and luers to peripheral and central vascular catheters. The potential for microbial contamination of catheters via these devices is currently unclear. A recently introduced connector, the 'Connecta Clave', was assessed by various in-vitro methods. The 'Connecta Clave' is specifically devised to separate external components from the fluid pathway. The compression seals of 50 devices were contaminated with 1 x 10(4) cfu Staphylococcus epidermidis, disinfected with isopropanol, and fluid passed through. Only one device allowed organisms to pass through, despite this challenge, representing a contamination rate of 2%. In comparison, when 50 connectors were challenged with 20 cfu of S. epidermidis, no organisms passed through the device during use. In the clinical situation, after manipulation, < 16 cfu of skin organisms were found associated with the compression seal of the devices. It is, therefore, likely that the contamination rates in clinical practice will be extremely low. Three methods of disinfecting the compression seals and associated rims were also evaluated. A combination of alcohol chlorhexidine spray, followed by a 70% isopropanol swab, resulted in the most efficacious disinfection. The isopropanol swabs produced an adequate disinfection rate. The overall results suggest that by use of specially designed connectors, not only are needlestick injuries reduced, but the likelihood of microbial contamination of catheters via the internal route may also be diminished.     

Women's health and the privatization of fertility control in Brazil

In Brazil, privatization of the public sphere and neglect of public health is part of a conservative modernization strategy that is dominated by elite groups. The politics of human reproduction, consistent with this pattern, have left women dependent on the private sector for access to the means of fertility control, in spite of the existence of a conceptually-advanced public programme for comprehensive health care for women--a programme which expressed the demands of, and is widely supported by, the women's movement. While both the rate of contraceptive use and the types of methods used (oral contraceptives and surgical sterilization) are modern, the privatization of fertility control has resulted in a complete separation between fertility control and health care for poor women, who are the vast majority. Evidence indicates that many, perhaps most, women accumulate the health effects of totally uncontrolled and incorrect use of oral contraceptives, including unwanted pregnancies and illegal abortions, in the end resorting to clandestine surgical sterilization, which is usually performed through unnecessary caesarean section. Data on reproductive morbidity and mortality, however, are virtually non-existent. International women's reproductive rights networks and alternative services for women have advocated greater empowerment for women, in terms of improved standards of self-care and increased power in the use of health services. As a result, a gender approach to reproductive health care is now being proposed for government programmes. The Brazilian case services as an example of the limits faced by such programmes when adopted in a wider context of unfavorable political conditions.     

Mental health care: Access, stigma, and effectiveness.

Discusses the lack of commitment by the US as a nation to ensure that high-quality mental health care will be provided to all who are in need. The mental health benefits under Medicare and Medicaid programs are meager at best. Psychologists and other nonphysician health care providers are not considered bona fide professionals. Prevention, program evaluation efforts, and the use of alternatives to traditional inpatient care, such as halfway houses and crisis intervention programs, are not treated under the current reimbursement system. An "efficacy proposal" created by US Senators D. K. Inouye and S. M. Matsunaga is described. The essence of the proposal was modeled after the current Food and Drug Administration requirements for safety and efficacy for all new drugs and medical devices. In addition to these 2 requirements, the notion of "appropriateness" or "cost-effectiveness" was added. This proposal, which was deleted in 1980, would have established an interdisciplinary commission comprised of representatives of both the scientific and clinical communities. The commission would have been charged with the responsibility for making recommendations as to what types of mental health services, and under what conditions, should be reimbursed under the Social Security Act. It is concluded that the establishment of an independent entity with the charge of seriously reviewing the "probably public benefit" of providing psychotherapy would be in the national interest of the US. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occurrence of Protozoan and Bacterial Pathogens in Water Samples from Small Water Systems in Mountainous Areas of Taiwan

Giardia, Cryptosporidium, Salmonella, and Shigella have emerged as waterborne pathogens of concern. Thirty water samples were collected from 10 small water systems in mountainous areas of Taiwan and investigated for the occurrence of these pathogens. In addition, the basic characteristics of each small water system were recorded, and each water sample was tested for several water quality parameters. The occurrence frequency was 10.0% for Giardia spp., 3.3% for Cryptosporidium spp. and Shigella flexneri, and 16.7% for Salmonella enterica. The highest correlation was found between the presence of Salmonella enterica and low water temperature, followed by the correlation between water turbidity and fecal coliform concentration. A low correlation was found between the presence of Giardia and the concentration of heterotrophic bacteria. The water samples from small water systems with filtration devices had a lower occurrence of pathogen microorganisms than those without filtration devices. The proportion of water samples with pathogenic microorganisms increased with the consumer population of the water systems, and the pathogen occurrence differed among the regions of the sampling sites. In order to prevent parasitic infection, the use of disinfection devices in small water systems would be needed.     

Suggestions for the uses of psychological devices in accord with legal and ethical standards.

Suggests that some traditional psychological practices no longer conform to current legal and ethical requirements and that several ethical standards in the official publications of the American Psychological Association are applicable to the use of psychological devices. In the treatment of problems with possible organic causes, collaborative relationships with physicians may be required. The Food and Drug Administration's recent classification of some psychological devices (e.g., biofeedback equipment) as medical devices is likely to impose new standards upon the distribution and use of psychological devices similar to those now required for medical devices. Failure to conform to these standards may be considered as evidence of negligent treatment under some state laws. Finally, these standards suggest that public statements and announcements about devices should be based upon scientifically acceptable evidence and that psychologists should not participate for personal gain in the commercial promotion of a proprietary or single-source device to the public. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gynaecology, forced sterilisation, and asylum in the USA

On September 30, 1996, the US Congress enacted a law to grant asylum protection to victims of forced sterilization, forced abortion, and other forms of coerced population control and to opponents of these practices. Before this time, the US Board of Immigration Appeals judged forced sterilization insufficient grounds for political asylum unless it was performed for some discriminatory reason. The authors of this article have examined five women who claimed they were forcibly sterilized in China and were granted political asylum in the US as a result. The average age of these women was 32 years, while the average duration since forced sterilization was 8.6 years. Since asylum applications are not filed according to cause, there are no estimates of the number of women seeking asylum in the US as a result of forced sterilization. The Chinese government claims it does not authorize forced sterilization, but local officials acknowledge it sometimes occurs. In many cases, sterilization is not formally coerced but required as a condition of employment. Consistency between the woman's claim of forced sterilization and medical or psychological reports is essential to the success of asylum applications. US physicians should be prepared to play a documentary role in the evaluation of such requests.     

An appearance of genocide: a review of governmental family-planning program policies

An increasing number of newspaper and magazine articles in the black community are charging U.S. government family planning programs with genocide, largely due to the insensitivity of program administrators. A large reason for this is the fact that abortions are free but medicines cost money. Much of this is due to the fact that the pharmaceutical industry is a profit-making venture in the U.S., but the appearance is still given that officials are more interested in stopping black babies than in curing black children. The Report of the Commission on Population Growth and the American Future recommended spending 10 times as much on birth control as on maternal and child health services. Title 10 of the Public Health Services Act also focuses on low-income families as does Title 4-A of the Social Security Act. In the early 1970s many Office of Economic Opportunity centers asked for family planning funds, which were freely available, and used them for maternal and child health, which is what the poor really wanted. The poor also report they feel a subtle coercion when on welfare and are afraid voluntary abortion will be followed by compulsory sterilization. State and local family-planning policies, including a number of bills which would have required compulsory sterilization after a welfare mother had a certain number of illegitimate children have fueled concern. Fortunately none of these bills ever became law, but their very introduction raises genocide charges. A 1968 study of 10 counties in North Carolina revealed that discriminatory attitudes were directed toward disadvantaged, public assistance women regardless of color. It is recommended that family planning services be merged with maternal and child health services, which might result in increased use in a less emotionally charged atmosphere, and a sharp curtailment in use of public funds to sterilize minors. Abortion policy can be retained because, unlike sterilization, abortion respects the right of program participants to decide when and how many children should be born.     

Programmable open-loop micropump insulin delivery system

The application of "closed-loop" glucose-controlled insulin infusion in metabolic research and in the management of diabetic patients in acute emergency situations has stimulated the development of portable insulin infusion devices intended for the long-term stabilization of glucose levels. Since in vivo glucose sensors with long-term accuracy and reliability are not yet available, the currently projected portable insulin infusion systems are the "open-loop" type. Such systems should be reliable, safe, programmable, lightweight, and small in size. In addition, the power requirements should be as low as possible to avoid the need for heavy batteries and/or periodic recharging. In turn, these requirements govern the design criteria for the most essential component of such an instrument, the insulin delivery pump. A micropump has been developed in an attempt to meet all desirable design features. Evaluation data are presented.     

Practical experiences with sexual sterilization following directives of the Ministry of Health 5/72, Codex paragraphy 27, law 20/66

In 1975, 35 women were administered artificial sterilizations using the Pomeroy technique, 6 for health reasons and 29 for socioeconomic reasons. All patients had already experienced 5 or more births and rejected any proposed contraceptives. Protocol for the operation under the sterilization law includes the patients nationality, IQ, reason for sterilization, and recommendations of the local board of Social Health. Sterilizations took place 1-2 days after birth, using general anesthesia and lasting approximately 15 minutes. Of the 29 women administered the operation for other than medical reasons, none experienced either early or late complications.